When Dr. Berman suggested a few weeks ago that I speak to you about the new roles of computers in medicine, I had thought that the appropriate thing to do would be to parade perhaps a dozen new medical computer techniques or procedures from the current literature before you and to expand briefly on the merits and opportunities as well as the potential dangers of each in practical use. Then I realized that this constituted an opportunity to do a first trial run on something much more important with you as a highly competent sample of friendly but constructively critical practicing physicians, medical scientists and administrators involved in efficient yet safe health care delivery.
It so happens that just four weeks ago today, at a similar early hour, I was asked by the Advanced Research Groups Conference of IBM, meeting at the Spring Hill Conference Center in Wayzata, to make an extended presentation on where I saw the forefront of computer technology and applications for the next few years. In putting together notes for this presentation I suddenly realized that practically every one of the forefront areas of computer science in general had its immediate and realistic counterpart in the medical front.
I realized, also, that the “limiting reaction”, the bottleneck to rapid beneficial application of the new concepts and hardware in each case was not in the theory or application itself, but in our socio-economic political acceptance of really new ideas. Perhaps there is safety in conservative inertia in medical and health science where human lives and communities are at stake, but on the other hand, there is urgency in improving the quality of health care delivered while increasing the sense of satisfaction of the individual patient, or “client” as he is now being called, while simultaneously cutting the cost of this improved care.
I am not talking pious economic theory: look at the hard data and you will see that we are running out of medical care money just as surely as we are running out of gasoline and we must do something more than “conserve” in each case if we are to survive. As the curve shows inescapably, we will, at the present rate, use up our total gross national product on health in only 80 years.
You see, then, that I must cast us in the role of “marketers” as well as inventors and developers of advanced medicine, and most of us, at least I can speak for myself, are very inept marketers and establishers of new forms of medical services that we devise.
Let us return now to the basic theme. I proposed seven areas of computer science
now technically feasible but not yet fully acceptable socially. Let me elaborate
briefly on the interpretation of each of these items and then let me run through
with slides some attempts that are currently being made in each of these fronts.
I regret that I have not had time and opportunity to develop each of these themes
with newest data, but then we would also be talking of several hours of material.
Let us keep the basic slide on hand as a tour guide as we plunge through applications.
1) The development of a generation of computers requiring no visible programmers.
2) Computers utilizing humans as sub-system components and featuring designed biomimetic meta-languages.
3) System design of a multi-level computer-implemented personally portable whole life medical record and para- meterized health maintenance guide.
4) Computers for the implementation of home medical health maintenance diagnosis and therapy.
5) Development of an intimately incorporated human test and interactive communication computer port.
6) Computer-assisted optimization as a replacement for adversary binary decision process in law, regulatory ordinances, determination of acceptable levels of health risk and implementation of Santosha index procedures.
7) Popular transponsive telecommunication terminals in the implementation of
public policy and decision making.